National Neonatal Audit Programme (NNAP) 2018 Annual Report on 2017 Data
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National Neonatal RCPCH Audits Audit Programme (NNAP) Annual report 2018 annual report on 2017 data RCPCH Royal College of Paediatrics and Child Health National Neonatal Audit Programme (NNAP) 2018 annual report on 2017 data The National Neonatal Audit Programme is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP). HQIP is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement in patient outcomes, and in particular, to increase the impact that clinical audit, outcome review programmes and registries have on healthcare quality in England and Wales. HQIP holds the contract to commission, manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP), comprising around 40 projects covering care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh Government and, with some individual projects, other devolved administrations and crown dependencies. www.hqip.org.uk/national-programmes © 2018 Healthcare Quality Improvement Partnership (HQIP) Published by RCPCH September 2018. The Royal College of Paediatrics and Child Health is a registered charity in England and Wales (1057744) and in Scotland (SCO38299) 2 National Neonatal Audit Programme 2018 report on 2017 data Acknowledgements The NNAP Project Board would like to thank all the doctors, nurses, administrators, data analysts and others who have given their time and effort to collect information for the audit and ensure its accuracy, and who have developed and carried out plans to improve the service they deliver. We would particularly like to thank the NNAP clinical leads in each unit, and the neonatal networks for their continued support. We would also like to thank the people and organisations that work closely with the NNAP but are not represented on the Project Board or Methodology and Dataset Group, including the National Maternity and Perinatal Audit (NMPA), the Independent Advisory Group of the Healthcare Quality Improvement Partnership (HQIP), and the Neonatal Critical Care Clinical Reference Group at NHS England. NNAP Project Board members Professor Anne Greenough, Professor of Neonatology and Clinical Respiratory Physiology, Chair of the NNAP Project Board Dr Sam Oddie, Consultant Neonatologist, NNAP Clinical Lead Vanessa Attrell, Network Manager, South East Coast Neonatal Network Dr Lisa Barker, Consultant Neonatologist Zoe Chivers, Head of Services, Bliss (to July 2018) Ellen Hallsworth, Parent Representative (to June 2018) Wendy Hodgson, Neonatal Nurses Association Representative Dr Chris Kissack, Consultant Neonatologist, Scottish Representative Dr Helen Mactier, Consultant Neonatologist, British Association of Perinatal Medicine Representative Professor Neena Modi, Professor of Neonatal Medicine, Neonatal Data Analysis Unit, Imperial College London Gina Outram, Neonatal Nurses Association Representative (to April 2018) Dr Colin Peters, Consultant Neonatologist, Scottish Representative Dr Siddhartha Sen, Consultant Neonatologist, Welsh Representative Mirek Skrypak, Associate Director for Quality and Development, Healthcare Quality Improvement Partnership Patrick Tully, NNAP Parent Representative Sarah Walker, Project Manager, Healthcare Quality Improvement Partnership Professor Andrew Wilkinson, Emeritus Professor of Paediatrics, University of Oxford Dr Amy Young, Trainee in Neonatal Medicine 3 National Neonatal Audit Programme 2018 report on 2017 data NNAP Methodology and Dataset Group members Dr Sam Oddie, Consultant Neonatologist, Chair of the NNAP Methodology and Dataset Group Dr Julie-Claire Becher, Consultant Neonatologist Dr Kate Blake, Consultant Neonatologist Charlotte Bradford, Information Manager, Yorkshire and Humber Neonatal Network Dr Sanjeev Deshpande, Consultant Neonatologist Jacki Dopran, Senior Nurse Elizabeth Gallagher, Network Manager, Wales Neonatal Network Rebecca Lemin, Network Manager, South West Neonatal Network Dr Yinru Lim, Trainee in Neonatal Medicine Dr Kate Palmer, Consultant Neonatologist Mehali Patel, Senior Research Officer, Bliss Dr Oliver Rackham, Consultant Neonatologist, RCPCH Clinical Lead for Audit NNAP Project Team* Dr Sam Oddie, Consultant Neonatologist, NNAP Clinical Lead Rachel Winch, NNAP Audit Manager, RCPCH Mark Hannigan, Clinical Standards and Quality Improvement Manager, RCPCH Dr Marcia Philbin, Assistant Director of Research and Policy, RCPCH Melanie David-Feveck, Project Administrator, RCPCH (to March 2018) Karina Green, Project Administrator, RCPCH (from March 2018) Sandeepa Arora, NNAP Data Analyst, NDAU (from March 2018) Kayleigh Ougham, NNAP Data Analyst, NDAU Dr Nicholas Longford, NNAP Statistician, NDAU *Note that members of the NNAP Project Team also sit on the Project Board and Methodology and Dataset Group. 4 National Neonatal Audit Programme 2018 report on 2017 data Table of contents 2018 annual report on 2017 data ................................................................................................... 2 Acknowledgements ........................................................................................................................ 3 Table of contents ............................................................................................................................. 5 Forewords ......................................................................................................................................... 6 Executive summary ......................................................................................................................... 8 1. Introduction ............................................................................................................................ 16 2. Key findings and recommendations ................................................................................. 23 3. Methods .................................................................................................................................. 54 4. Case studies: how NNAP supports local quality improvement ................................... 62 5. Full NNAP results .................................................................................................................. 70 Appendix A: Data completeness and unit level of participating units ............................. 143 Appendix B: Recommendations by audience ....................................................................... 149 Appendix C: Glossary and abbreviations ................................................................................ 158 Appendix D: Useful resources ................................................................................................... 160 Appendix E: Matching method of comparing outcomes for BPD ..................................... 163 Appendix F: “Pathogens” in the NNAP .................................................................................... 165 References .................................................................................................................................... 167 5 National Neonatal Audit Programme 2018 report on 2017 data Forewords I am pleased to introduce the 11th annual report of the National Neonatal Audit Programme, which has been run by the Royal College of Paediatrics and Child Health since its inception in 2006. The audit celebrates some key achievements in neonatal care this year; more very preterm babies are being admitted to neonatal units with a normal temperature and rates of magnesium sulphate administration to mothers at risk of very preterm birth have increased notably (from 53% with 17% missing data, to 64% with 8% missing data). Variation, however, continues to exist between neonatal units and neonatal networks. There are clear opportunities for units and networks to use their NNAP data as a driver for quality improvement activities. The audit achieves excellent engagement from the neonatal community and the high levels of data completeness achieved in most audit measures mean that the audit continues to be a robust source of information, enabling the neonatal community to make best use of their results to drive change. The NNAP reports for the first time this year on new measures of parental partnership in neonatal care. The development of these new measures is a credit to the NNAP parent representatives Ellen Hallsworth and Patrick Tully and Bliss representative Zoe Chivers. Ellen and Zoe step down this year after several years of providing highly valuable insight to the NNAP. I thank them for their contribution to the audit. Thank you also to those involved in writing this report and developing its recommendations, including the NNAP Project Board, Methodology and Dataset Group, the Project Team and Clinical Lead Professor Sam Oddie. Finally, I would like to thank the neonatal and wider perinatal teams for providing their essential input into the audit. Professor Anne Greenough, Vice President Science and Research Chair of the NNAP Project Board Royal College of Paediatrics and Child Health Follow @RCPCHtweets | www.rcpch.ac.uk 6 National Neonatal Audit Programme 2018 report on 2017 data The NNAP expects, this year, to achieve full coverage of the 182 neonatal units in England, Wales and Scotland. Engagement in this national audit is accepted by many national bodies to be a key indicator of